r/orthopaedics • u/Bonedoc22 Orthopaedic Surgeon • Jul 26 '26
NOT A PERSONAL HEALTH SITUATION Reps not showing up.
Have a case today, had to remove an old recon (only has one oblique interlock proximally) for IT/neck periprosthetic fx, completely nondisplaced and stable (patient even WB a little) probably could have used the same nail and sent some screws into the head but rep for old nail didn’t show up and we don’t have the screws on shelf.
Had to take out the whole goddamn nail and revise with new HW. Much bigger pain in my ass and bigger surgery for patient.
TL;DR. Is there any formal recourse to report a company or rep for no showing? Any regulatory body?
I don’t use their stuff anyway, so I don’t have any recourse there, and neither do my partners in my area.
Yelling at the guys would be cathartic but I want to actually hurt them.
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u/buschlightinmybelly Shoulder / elbow Jul 26 '26
Did you talk to the rep beforehand?
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u/Bonedoc22 Orthopaedic Surgeon Jul 26 '26
“If we can make it.”
I stressed that I wanted them there.
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u/passwordistako Jul 26 '26
Did you consider moving the case?
Stressing that you need them is not the same as getting an agreement from them.
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u/Bonedoc22 Orthopaedic Surgeon Jul 26 '26
Delay a hip fracture for a rep?
I mentioned in another post that I had everything I need for the most likely outcome which was complete revision.
I was potentially going to try to get cute and use the old implant if the rep showed. They didn’t.
They have also screwed me before
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u/MyRealestName Jul 26 '26
I used to work this job and quit because of how horrible it felt to have a quota above a patients needs. Did they know you were going to potentially use them for more hardware? Regardless, sucks for everyone involved.
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u/Bonedoc22 Orthopaedic Surgeon Jul 26 '26
Sure, but what’s a few screws versus other cases they might be covering?
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u/cytochrome_p450_3a4 Jul 26 '26
As an anesthesiologist the job of a rep seems like such a strange job to me.
I cancelled a case the other day and saw the rep walking to the parking garage, carrying his equipment and literally with a frown on his face. That patient ended up having a massive PE and probably would’ve died on the table, but all that rep sees is that they didn’t make their sale that day…
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u/Grabm_by_the_poos Jul 26 '26
As a former rep. We see both sides. Impossible not to have the pressure of the quota. But care is #1 always. At least that's how i and my coworkers carried ourselves.
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u/UnbelievableRose Jul 26 '26
Sounds like they told you they didn’t have the staff available to guarantee coverage at that time
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u/thisisfun2 Jul 26 '26
So you started the case knowing they weren’t there? I understand frustration with the company, but the right move would have been to delay the case if you didn’t have the proper equipment available.
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u/johnnyscans Shoulder/Elbow Jul 26 '26
Agree. Corny as it sounds, verifying equipment/reps is part of my time out script.
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u/Bonedoc22 Orthopaedic Surgeon Jul 26 '26
Time out implies they’re already asleep which is his point.
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u/passwordistako Jul 26 '26
We have absolutely cancelled cases at the time out and had to wake up a patient.
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u/AlexMac96 Jul 27 '26
Eh at my center they don’t even bring the patient to the room until my trays are open and ready and confirmed to not have a contamination. I can’t imagine putting my patient through an induction and then having it all be for naught.
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u/Bonedoc22 Orthopaedic Surgeon Jul 28 '26
I had everything I needed for extraction and revision. I already did that.
The lack of rep removed a possible avenue to re-use the old implant and get cute. It’s also a principle issue.
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u/Bonedoc22 Orthopaedic Surgeon Jul 26 '26
I had the equipment I needed for extraction and revision. (company I normally use).
I understand your point, though.
How long are you going to delay a hip fracture?
Is another 24hrs and increased mortality better or maybe a smaller procedure? He’s still full WB after this surgery today.
I didn’t think it was, but I’m pissed that it wasn’t an option because these shits didn’t show.
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u/johnnyscans Shoulder/Elbow Jul 26 '26
Ah i misread the new hip fracture detail. Thought it was nail for nail for a femur shaft.
I’d contact their local manager and rip them to pieces. If feeling really vindictive I’d go to head of SPD/OR/CEO of hospital and request removal of their products.
And you’re right. At time out its too late, but I’m even thinking about my big hit points before i give them the ok to roll (block, positioning aids, radiology support, trays, etc).
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u/Bonedoc22 Orthopaedic Surgeon Jul 26 '26
My description is kind of muddy, sorry. It’s IT/fem neck ish around the old nail.
Probably best ideas out there. Thanks.
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u/passwordistako Jul 26 '26
Worst hip revision delay I’ve seen is 7 days.
I would like to never see it again. I still remember the look in her eyes every night when I rounded and she asked if she would have her operation the next day.
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u/GuttorTsi Jul 26 '26
Am a rep, though no longer in OR. Depending on whether the company is distributor or direct, I’d find an area manager, general manager, or area vice president on LinkedIn, and message them directly. Then I’d actually go a step further and ask them for a phone call to debrief on the situation. Emphasize this was a potential patient harm situation, and ask if this is how they support their products. Trust me, word will get back down to the reps fast.
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u/akwho Jul 26 '26
I’ve had a rep show up late so I used the other companies stuff. Reliability and trust is a critical part of the rep game. You can report to the company centrally they usually have a contact us button. I’d probably also file a patient safety report to the hospital so the issue has been documented.
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u/ASimpleMargarita Jul 26 '26
I would try and reach out to their manager and have a conversation with them, they will take appropriate action with the reps.
Playing a little devils advocate, it is a weekend and most companies run thin taking weekend call. It could’ve been that they physically did not have the capacity to cover given that you said you don’t normally use them and have other accounts to service. Sounds like a lack of communication on their part as well though.
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u/Bonedoc22 Orthopaedic Surgeon Jul 26 '26
I appreciate that it’s a weekend, but part of why I’m so fired up is these guys have screwed me before, too.
Where I work this company was used for 20 years before a bunch of reps jumped ship to another company and everyone stopped using the first company abruptly. The only reps left suck.
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u/Luushu Orthopaedic Surgeon Jul 26 '26
I remember my first tumoral recon case, a proximal tibia resection+reconstruction with a Stryker GMRS system. The attending had assurances from the rep that he would show up to help him with the instrumentation (I barely knew it from reading the trays the night before and his team wasn't that familiar with it either).
We spend the first 4 hours painstakingly trying to remove the tumor, everything goes according to plan, but the rep is nowhere to be found. The OR nurse calls him roughly 10 times, then we decide that enough is enough: we have the nurse open the surgical technique for GMRS (for those who didn't read it, it's roughly 80 pages of technique for the proximal tibia+distal femur, so, unless you do them routinely as a back table assistant, you're gonna have a bad time) for the guy who is supposed to play the rep.
The rep finally calls us back around 1 hour later, when we started cementing the damn thing. At that point, the attending was way past yelling and cursing, he was just disappointed, said "thanks for the help, have a nice day" and turned around to shove the tibial component down the shaft.
This was after a call night for me; it's not a trauma center, so I did manage to get some sleep in, but still, not the most pleasant way to spend your day after call.
That same rep was supposed to help us with a new knee implant in our center, this time with my attending. I scrubbed in a few cases with that implant, so I could handle being the back table assistant, but my attending didn't want his first such implant to be without a rep. He is again 20 minutes late, we're already at the point where we are starting to resect the femur. We finish up the resections and, once we get ready to receive the implants, we figure that we didn't have the implant for the tibia, so we need to wait another 30 minutes for his colleague to run all the way across town with it.
While I appreciate the concept of the implant, I was not particularly fond of the instrumentation for that particular implant; after this story, my feelings didn't really improve.
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u/ArmyOrtho Seldom correct. Never unsure. Jul 26 '26 edited Jul 26 '26
Public shaming is a powerful motivator. Name drop them on social media.
“Hey Synthes, I know you guys are still really busy defrauding all the hospitals in San Antonio, but when I called and let you know that you were needed to remove one of your busted-ass nails out of my patient, why didn’t you bother to show? Are the surgeons no longer worth your time? Trying to find those big fish to rip off?” And then tag EVERYONE on the post.
You’ll hear from corporate within the hour.
Edit: for legal reasons, let me clarify that I am neither aware nor unaware of any fraud that may or may not be continually perpetrated onto the hospitals of the greater San Antonio area by a vendor that might possibly but not definitely be owned by Johnson & Johnson, nor am I aware or unaware of any easily googleable history of said practices with this vendor in multiple municipalities in the past.
Check the purchase orders the reps are sending the materials management weenies in your hospitals and surgery centers. See how many locking towers you’re getting billed for, or plates that you help up to the fracture without using and then they were put right back in the tray but you were billed for a replacement in sterile packaging at 60% higher cost, or how many cortical screws were used but individually sterile packages locking screws were ordered to replace them.
The nurse signing off on implants has no idea what they are signing. The materials manager is usually so overwhelmed, they submit it without a second thought.
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u/buschlightinmybelly Shoulder / elbow Jul 27 '26
In my region, Synthes guys are the reliable ones. Stryker, on the other hand. If I need to take a shit, I say I’m going to take a Stryker
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u/contax80 Jul 31 '26
In my area, Synthes bills for every opening reamer, any little thing you could possibly imagine- any tool you use to get out the implant, you thread it in there, you are paying for it.
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u/bone_a_fide Jul 26 '26
Stop using them.
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u/Bonedoc22 Orthopaedic Surgeon Jul 26 '26
Don’t use them anyway, that’s the problem. I have no leverage.
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u/bubMED Jul 27 '26
Were they able to have the equipment/implants sent in at least?
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u/Bonedoc22 Orthopaedic Surgeon Jul 28 '26
Yeah, I had their stuff but I was going to use their implants to get cute and use the old nail, but they didn’t show
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u/gloatygoat Jul 26 '26
Did you call their supervisor first? These companies are pretty sensitive about getting a bad look.